Provider Demographics
NPI:1053463018
Name:BUTSCHER, HEATHER A (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:BUTSCHER
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 EUCLID AVE
Mailing Address - Street 2:MAILSTOP 5021
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1716
Mailing Address - Country:US
Mailing Address - Phone:216-831-8342
Mailing Address - Fax:216-844-0226
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:LKSD 5021
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-831-8342
Practice Address - Fax:216-595-5357
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD5682133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered